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Treatment Integrity in Interventions for Children Diagnosed with DSM-5 Disorders

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Assessing Impairment

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Abstract

Treatment (also known as , , or ) refers to the reliable and accurate implementation of an intervention. Treatment integrity (TI) is a term that refers to how the treatment which is actually administered is similar to the theoretical and procedural components of the intended treatment model (Dusenbury, Brannigan, Falco, & Hansen, 2003; Nezu & Nezu, 2008; Reed & Codding, 2011). Failing to control for treatment integrity can result in several issues (Livanis, Benvenuto, Mertturk, & Hanthorn, 2013). First, if a treatment is not implemented with fidelity, clinicians cannot reliably evaluate the effects of the independent variable upon the dependent variable (Cooper, Heron, & Heward, 2007; Kazdin, 2011). In these instances, the intervention takes on multiple “lives”—one which exists on paper and one which is actually implemented—both of which may be similar to one another but are not exactly the same (Livanis & Mercer, in press). Second, there is the potential lack of improvement among clients. When interventions are implemented with higher rates of treatment integrity, there is a stronger association with positive treatment outcomes (DiGennaro, Martens, & Kleinman, 2007; DiGennaro, Martens, & McIntyre, 2005; Erhardt, Barnett, Lentz, Stollar, & Raifin, 1996; Hogue et al., 2008). When well-designed interventions are implemented correctly, there tends to be positive effects on clients.

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References

  • Allen, K. D., & Warzak, W. J. (2000). The problem of parental non-adherence in clinical behavior analysis: Effective treatment is not enough. Journal of Applied Behavior Analysis, 33(3), 373–391. doi:10.1901/jaba.2000.33-373.

    Article  PubMed  PubMed Central  Google Scholar 

  • American Psychological Association. (2005, August). Policy statement on evidence-based practice in psychology. Retrieved from http://www.apapracticecentral.org/ce/courses/ebpstatement.pdf

  • Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91–97. doi:10.1901/jaba.1968.1-91.

    Article  PubMed  PubMed Central  Google Scholar 

  • Barber, J. P., Gallop, R., Crits-Chirstoph, P., Frank, A., Thase, M. E., Weiss, R. D., et al. (2006). The role of therapist adherence, therapist competence, and alliance in predicting outcome of individual drug counseling: Results from the National Institute Drug Abuse Collaborative Cocaine Treatment Study. Psychotherapy Research, 16, 229–240. doi:10.1080/10503300500288951.

    Article  Google Scholar 

  • Bergan, J. R., & Kratochwill, T. R. (1990). Behavioral consultation and therapy. New York: Plenum Press.

    Google Scholar 

  • Burgio, L. D., Engel, B. T., Hawkins, A. M., McCormick, K., Schieve, A., & Jones, L. T. (1990). A staff management system for maintaining improvements in continence with elderly nursing home residents. Journal of Applied Behavior Analysis, 23, 111–118. doi:10.1901/jaba.1990.23-111.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cochrane, W. S., & Laux, J. M. (2008). A survey investigating school psychologists’ measurement of treatment integrity in school-based interventions and their beliefs in their importance. Psychology in the Schools, 45, 499–507. doi:10.1002/pits.20319.

    Article  Google Scholar 

  • Codding, R. S., Feinberg, A. B., Dunn, E. K., & Pace, G. M. (2005). Effects of immediate performance feedback on implementation of behavior support plans. Journal of Applied Behavior Analysis, 38, 205–219. doi:10.1901/jaba.2005.98-04.

    Article  PubMed  PubMed Central  Google Scholar 

  • Codding, R. S., Livanis, A., Pace, G., & Vaca, L. (2008). Using performance feedback to improve treatment integrity of classwide behavior plans: An investigation of observer reactivity. Journal of Applied Behavior Analysis, 41, 417–422. doi:10.1901/jaba.2008.41-417.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Merrill Prentice Hall.

    Google Scholar 

  • Cowan, R. J., & Sheridan, S. M. (2003). Investigating the acceptability of behavioral interventions in applied conjoint behavioral consultation: Moving from analog conditions to naturalistic settings. School Psychology Quarterly, 18(1), 1–21.

    Article  Google Scholar 

  • Coyle, C., & Cole, P. (2004). A video-taped self-modeling and self-monitoring treatment program to decrease off-task behaviour in children with autism. Journal of Intellectual and Developmental Disability, 29, 3–15. doi:10.1080/08927020410001662642.

    Article  Google Scholar 

  • DiGennaro, F. D., Martens, B. K., & Kleinman, A. E. (2007). A comparison of performance feedback procedures on teachers’ treatment implementation integrity and students’ inappropriate behavior in special education classrooms. Journal of Applied Behavior Analysis, 40, 447–461. doi:10.1901/jaba.2007.40-447.

    Article  PubMed  PubMed Central  Google Scholar 

  • DiGennaro, F. D., Martens, B. K., & McIntyre, L. L. (2005). Increasing treatment integrity through negative reinforcement: Effects on teacher and student behavior. School Psychology Review, 34(2), 220–231.

    Google Scholar 

  • DiGennaro-Reed, F. D., Codding, R., Catania, C. N., & MaGuire, H. (2010). Effects of video modeling on treatment integrity of behavioral interventions. Journal of Applied Behavior Analysis, 43, 291–295. doi:10.1901/jaba.2010.43-291.

    Article  PubMed  PubMed Central  Google Scholar 

  • Domitorvich, C. E., Bradshaw, C. P., Poduska, J. M., Hoagwood, K., Buckley, J. A., Olin, S., et al. (2008). Maximizing the implementation quality of evidence-based preventive interventions in schools: A conceptual framework. Advances in School Mental Health Promotion, 1(3), 6–28. doi:10.1080/1754730X.2008.9715730.

    Article  Google Scholar 

  • Dusenbury, L., Brannigan, R., Falco, M., & Hansen, W. B. (2003). A review of research on fidelity of implementation: Implications for drug abuse prevention in school settings. Health Education Research: Theory and Practice, 18(2), 237–256. doi:10.1093/her/18.2.237.

    Article  Google Scholar 

  • Elliot, S. N. (1988). Acceptability of behavioral treatments in educational settings. In J. C. Witt, S. N. Elliott, & F. M. Gresham (Eds.), Handbook of behavior therapy (pp. 121–150). New York: Plenum Press.

    Chapter  Google Scholar 

  • Erhardt, K. E., Barnett, D. W., Lentz, F. E., Stollar, S. A., & Raifin, L. H. (1996). Innovative methodology in ecological consultation: Use of scripts to promote treatment acceptability and integrity. School Psychology Quarterly, 11, 149–168. doi:10.1037/h0088926.

    Article  Google Scholar 

  • Foster, S., & Cone, J. (1986). Design and use of direct observation. In A. Ciminero, K. Calhoun, & H. Adams (Eds.), Handbook of behavioral assessment (2nd ed., pp. 253–324). New York: Wiley Interscience.

    Google Scholar 

  • Foxx, R. M. (1996). Twenty years of applied behavior analysis in treating the most severe problem behavior: Lessons learned. The Behavior Analyst, 19(2), 225–235.

    PubMed  PubMed Central  Google Scholar 

  • Greene, R. W. (2001). The explosive child: A new approach for understanding and parenting easily frustrated, chronically inflexible children. New York: Perennial.

    Google Scholar 

  • Greene, R. W., & Albon, J. S. (2006). Treating explosive kids: The collaborative problem solving approach. New York: Guilford Press.

    Google Scholar 

  • Gresham, F. M. (1989). Assessment of treatment integrity in school consultation and prereferral intervention. School Psychology Review, 18, 37–50.

    Google Scholar 

  • Gresham, F. M. (1996). Treatment integrity in single-subject research. In R. D. Franklin, D. B. Allison, & B. S. Gorman (Eds.), Design and analysis of single-case research (pp. 93–117). Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Gresham, F. M. (2014). Measuring and analyzing treatment integrity data in research. In L. M. Sanetti & T. R. Kratochwill (Eds.), Treatment integrity: A foundation for evidence based practice in applied psychology. Washington, DC: American Psychological Association.

    Google Scholar 

  • Guercio, J. M., Dixon, M. R., Soldner, J., Shoemaker, Z., Zlomke, K., Root, S., et al. (2005). Enhancing staff performance measures in an acquired brain injury setting: Combating the habituation to organizational behavioral interventions. Behavioral Interventions, 20, 91–99. doi:10.1002/bin.174.

    Article  Google Scholar 

  • Happe, D. (1982). Behavior intervention: It doesn’t do any good in your briefcase. In J. Grimes (Ed.), Psychological approaches to problems of children and adolescents (pp. 15–41). Des Moines, IA: Iowa Department of Public Instruction.

    Google Scholar 

  • Hayes, S. C., & Wilson, K. G. (1993). Some applied implications of a contemporary behavior-analytic account of verbal events. The Behavior Analyst, 16(2), 283–301.

    PubMed  PubMed Central  Google Scholar 

  • Hogue, A., Henderson, C. E., Dauber, S., Barajas, P. C., Fried, A., & Liddle, H. A. (2008). Treatment adherence, competence, and outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting and Clinical Psychology, 76(4), 544–555. doi:10.1037/0022-006X.76.4.544.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jones, H. A., Clark, A. T., & Power, T. J. (2008). Expanding the concept of intervention integrity: A multidimensional model of participant engagement. Balance, 23(1), 4–5.

    Google Scholar 

  • Kazdin, A. E. (1986). Comparative outcome studies of psychotherapy: Methodological issues and strategies. Journal of Consulting and Clinical Psychology, 54, 95–105. doi:10.1037/0022-006X.54.1.95.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E. (2011). Single-case research designs. New York: Oxford University Press.

    Google Scholar 

  • Kazdin, A. E. (2015). Clinical dysfunction and psychosocial interventions: The interplay of research, methods, and conceptualization of challenges. Annual Review of Clinical Psychology, 11, 25–52.

    Article  PubMed  Google Scholar 

  • LeBlanc, M., Ricciardi, J. N., & Luiselli, J. K. (2005). Improving discrete trial instruction by paraprofessional staff through an abbreviated performance feedback intervention. Education and Treatment of Children, 28(1), 76–82.

    Google Scholar 

  • Livanis, A., Benvenuto, S., Mertturk, A., & Hanthorn, C. A. (2013). Treatment integrity in autism spectrum disorder interventions. In S. Goldstein & J. A. Naglieri (Eds.), Interventions for autism spectrum disorders: Translating science into practice (pp. 19–37). New York: Springer.

    Chapter  Google Scholar 

  • Livanis, A., & Mercer, S. H. (in press). The effects of graduated treatment introduction and performance feedback on treatment integrity for complex behavior intervention plans. Unpublished manuscript.

    Google Scholar 

  • McIntyre, L. L., Gresham, F. M., DiGennaro, F. D., & Reed, D. D. (2007). Treatment integrity of school-based interventions with children in the journal of applied behavior analysis 1991–2005. Journal of Applied Behavior Analysis, 40(4), 659–672.

    Article  PubMed  Google Scholar 

  • McLeod, B. D., Southam-Gerow, M. A., & Weisz, J. R. (2009). Conceptual and methodological issues in treatment integrity measurement. School Psychology Review, 38(4), 541–546.

    Google Scholar 

  • Meichenbaum, D., & Turk, D. C. (1987). Facilitating treatment adherence: A practitioner’s guidebook. New York: Plenum Press.

    Book  Google Scholar 

  • Mortensen, B. P., & Witt, J. C. (1998). The use of weekly performance feedback to increase teacher implementation of a prereferral intervention. School Psychology Review, 27, 613–627.

    Google Scholar 

  • Mouzakitis, A. (2010). The effects of self-monitoring training and performance feedback on the treatment integrity of behavior support plans for children with autism. Unpublished doctoral dissertation, The Graduate Center of the City University of New York, New York.

    Google Scholar 

  • National Association of School Psychologists. (2010a). Principles for professional ethics. Retrieved from http://www.nasponline.org/standards/2010standards/1_%20Ethical%20Principles.pdf

  • National Association of School Psychologists. (2010b). Model for comprehensive and integrated school psychological services. Retrieved from http://www.nasponline.org/standards/2010standards/2_PracticeModel.pdf

  • Nezu, A. M., & Nezu, C. M. (2008). Treatment integrity. In D. McKay (Ed.), Handbook of research methods in abnormal and clinical psychology (pp. 351–363). New York: Sage.

    Google Scholar 

  • Noell, G. H., & Gansle, K. A. (2014). The use of performance feedback to improve intervention implementation in schools. In L. M. Sanetti & T. R. Kratochwill (Eds.), Treatment integrity: A foundation for evidence-based practice in applied psychology. Washington, DC: American Psychological Association.

    Google Scholar 

  • Noell, G. H., Witt, J. C., Gilbertson, D. N., Ranier, D. D., & Freeland, J. T. (1997). Increasing teacher interventions implementation in general education settings through consultation and performance feedback. School Psychology Quarterly, 12, 77–88.

    Article  Google Scholar 

  • Noell, G. H., Witt, J. C., LaFleur, L. H., Mortenson, B. P., Ranier, D. D., & LeVelle, J. (2000). Increasing intervention implementation in general education following consultation: A comparison of two follow-up strategies. Journal of Applied Behavior Analysis, 33, 271–284. doi:10.1901/jaba.2000.33-271.

    Article  PubMed  PubMed Central  Google Scholar 

  • Perepletchikova, F. (2014). Assessment of treatment integrity in psychotherapy research. In L. M. Sanetti & T. R. Kratochwill (Eds.), Treatment integrity: A foundation for evidence based practice in applied psychology. Washington, DC: American Psychological Association.

    Google Scholar 

  • Perepletchikova, F., & Kazdin, A. E. (2005). Treatment integrity and therapeutic change: Issues and research recommendations. Clinical Psychology: Science and Practice, 12(4), 365–383. doi:10.1093/clipsy/bpi045.

    Google Scholar 

  • Petscher, E. S., & Bailey, J. S. (2006). Effects of training, prompting and self-monitoring on staff behavior in a classroom for students with disabilities. Journal of Applied Behavior Analysis, 39, 215–226. doi:10.1901/jaba.2006.02-05.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reed, F. D., & Codding, R. S. (2011). Intervention integrity assessment. In J. K. Luiselli (Ed.), Teaching and behavior support for children and adults with autism spectrum disorder (pp. 38–47). New York: Oxford University Press.

    Google Scholar 

  • Reichow, B., & Volkmar, F. R. (2011). Evidence-based practices in autism: Where we started. In B. Reichow, P. Doehring, D. V. Cicchetti, & F. R. Volkmar (Eds.), Evidence-based practices and treatments for children with autism (pp. 3–24). New York: Springer.

    Chapter  Google Scholar 

  • Richman, G. S., Riordan, M. R., Reiss, M. L., Piles, D. A. M., & Bailey, J. S. (1988). The effects of self-monitoring and supervisor feedback on staff performance in a residential setting. Journal of Applied Behavior Analysis, 21, 401–409. doi:10.1901/jaba.1988.21-401.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sanetti, L. M., & Kratochwill, T. R. (2014). Introduction: Treatment integrity in psychological research and practice. In L. M. Sanetti & T. R. Kratochwill (Eds.), Treatment integrity: A foundation for evidence-based practice in applied psychology. Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Schulte, A. C., Easton, J. E., & Parker, J. (2009). Advances in treatment integrity research: Multidisciplinary perspectives on the conceptualization, measurement, and enhancement of treatment integrity. School Psychology Review, 38(4), 460–475.

    Google Scholar 

  • Skotarczak, L., & Lee, G. K. (2015). Effects of parent management training programs on disruptive behavior for children with a developmental disability: A meta-analysis. Research in Developmental Disabilities, 38, 272–287.

    Article  PubMed  Google Scholar 

  • Wheeler, J. J., Baggett, B. A., Fox, J., & Blevins, L. (2006). Treatment integrity: A review of intervention studies conducted with children with autism. Focus on Autism and Other Developmental Disabilities, 21(1), 45–54. doi:10.1177/10883576060210010601.

    Article  Google Scholar 

  • Witt, J. C., Moe, G., Gutkin, T. B., & Andrews, L. (1984). The effect of saying the same thing in different ways: The problem of language and jargon in school-based consultation. Journal of School Psychology, 22, 361–367. doi:10.1016/0022-4405(84)90023-2.

    Article  Google Scholar 

  • Witt, J. C., Noell, G. H., LaFleur, L. H., & Mortenson, B. P. (1997). Teacher use of interventions in general education: Measurement and analysis of the independent variable. Journal of Applied Behavior Analysis, 30, 693–696. doi:10.1901/jaba.1997.30-693.

    Article  PubMed Central  Google Scholar 

  • Yeaton, W. H., & Sechrest, L. (1981). Critical dimensions in the choice and maintenance of successful treatments: Strength, integrity, and effectiveness. Journal of Consulting and Clinical Psychology, 49(2), 156.

    Google Scholar 

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Authors and Affiliations

  1. Philadelphia College of Osteopathic Medicine, 226 Rector Street, Philadelphia, PA, 19128, USA

    Samantha Benevenuto Skolnik Psy.D.

  2. Long Island University - Brooklyn Campus, Dept. of Counseling and School Psychology, 9 Hanover Place, Brooklyn, NY, 11217, USA

    Andrew Livanis Ph.D.

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  1. Samantha Benevenuto Skolnik Psy.D.
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  2. Andrew Livanis Ph.D.
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Correspondence to Andrew Livanis Ph.D. .

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Editors and Affiliations

  1. Learning and Behavior Center , Salt Lake City, Utah, USA

    Sam Goldstein

  2. Curry School of Education, University of Virginia , Centerville, Virginia, USA

    Jack A. Naglieri

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Skolnik, S.B., Livanis, A. (2016). Treatment Integrity in Interventions for Children Diagnosed with DSM-5 Disorders. In: Goldstein, S., Naglieri, J. (eds) Assessing Impairment. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7996-4_16

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